Study Time Period Research Articles

Synergistic effects of social determinants of health and race-ethnicity on 30-day all-cause readmission disparities: a retrospective cohort study

ObjectiveThe objective of this study is to assess the effects of social determinants of health (SDOH) and race-ethnicity on readmission and to investigate the potential for geospatial clustering of patients...

Is 90 the new 80? Temporal trends in nonagenarians undergoing percutaneous coronary interventions

BackgroundCoronary artery disease (CAD) is a leading cause of death in the elderly population. Data regarding percutaneous coronary interventions (PCIs) in nonagenarians are scarce, and differences in long term outcomes between generations remain unclear. We aimed to study the pattern and temporal trends of nonagenarians treated with PCI. Materials and Methods: A total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year. Materials and MethodsA total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year. ResultsThe number of nonagenarians undergoing PCI has increased substantially during the study time period, from 89 patients in the earlier time period (2009-2014) to 133 patients in the later time period (2015-2020). At 1-year, nonagenarians had significantly higher rates of both death (24.3% vs. 14.9%, p<0.01), and MACE (30.6% vs. 22.0%, p<0.01), as compared to octogenarians. The cumulative survival rate was higher among octogenarians both in the early and late time period (p<0.01 and p=0.039, respectively). A significant reduction in nonagenarian MACE rates were observed during the study time period, resulting in a non-significant difference in MACE rates in the later time period between both groups. ConclusionThe number of nonagenarians who undergo PCI is on the rise. While their clinical outcomes are inferior as compared to younger age groups, improvement was noted in the late time period.

Patterns of acute hospital and specialist palliative care use among people with non-curative upper gastrointestinal cancer

PurposeUpper gastrointestinal (GI) cancers contribute to 16.7% of UK cancer deaths. These patients make high use of acute hospital services, but detail about palliative care use is lacking. We aimed to determine the patterns of use of acute hospital and hospital specialist palliative care services in patients with advanced non-curative upper GI cancer.MethodsWe conducted a service evaluation of hospital use and palliative care for all patients with non-curative upper GI cancer seen in one large hospital, using routinely collected data (2019–2022). We report and characterise hospital admissions and palliative care within the study time period, using descriptive statistics, and multivariable Poisson regression to estimate the unadjusted and adjusted incidence rate ratio of hospital admissions.ResultsThe total with non-curative upper GI cancer was 960. 86.7% had at least one hospital admission, with 1239 admissions in total. Patients had a higher risk of admission to hospital if: aged ≤ 65 (IRR for 66–75 years 0.71, IRR 76–85 years 0.68; IRR > 85 years 0.53; p < 0.05), or lived in an area of lower socioeconomic status (IMD Deciles 1–5) (IRR 0.90; p < 0.05). Over the 4-year period, the rate of re-admission was higher in patients not referred to palliative care (rate 0.52 readmissions/patient versus rate 1.47 readmissions/patient).ConclusionPeople with advanced non-curative gastrointestinal cancer have frequent hospital admissions, especially if younger or from areas of lower socioeconomic status. There is clear association between specialist palliative care referral and reduced risk of hospitalisation. This evidence supports referral to specialist palliative care.

Characterizing clinical trials for CAR T targeting solid tumors from 2018 to 2023: A systematic review.

e15080 Background: In the last decade, there have been many advances in the treatment of solid tumors, including new chemotherapy agents, immunotherapy, and most recently, cellular therapies. Chimeric antigen receptor T-cell (CAR T) therapy, first approved for acute lymphoblastic leukemia in 2017, represented a paradigm shift in hematologic malignancies, producing response rates that dramatically outpaced alternative regimens in a relapsed/refractory patient setting. Approvals in large B-cell lymphomas and multiple myeloma followed. Excited by the potential of CAR T, investigators worldwide have initiated trials to investigate the use of CAR T in solid tumors. This review explores the trials conducted globally, evaluating the potential molecular targets and the status of current clinical trials. Methods: This systematic review identified CAR T clinical trials specifically targeting solid tumors starting in 2018 to 2023 registered at ClinicalTrials.gov as of January 8, 2024. Trial-related variables including trial phase, primary trial site location, primary endpoints, start and end dates, and molecular target were captured. Results: We screened 110 clinical trials, ultimately including 103 studies for analysis after excluding trials without a CAR T construct in the methods. The number of new clinical trials increased over time, with a significantly larger increase (440%) seen with non-US sponsors compared to US sponsors (100%), p&lt; 0.0001. Only 19 trials (18%) are/were being conducted in the United States in the studied time period. There were 33 unique molecular targets used, with mesothelin (17%), and the claudin protein family (13%) as the most frequented targets. Conclusions: The success that CAR T has demonstrated in hematologic malignancies has created great hope in solid tumor malignancies, although tempered by differences between the two categories. Unlike hematologic cancers, solid tumors exhibit significant biomarker variation, with interpatient biomarker expression varying greatly, even within the same tissue diagnosis. To deal with this issue, the majority of clinical trials that were reviewed here were not restricted to a single disease location such as breast cancer or esophageal cancer but were rather restricted by the expression of the targeted epitope, to allow for the heterogeneity inherent in these tumors. As presented here, substantial efforts are being made worldwide to improve these technologies, but the United States appears to be lagging in clinical trial efforts, compared to other nations. Further investigation is warranted into this topic, as the usage of CAR T quickly spreads from a therapy only used in hematology to one with promise in solid tumors, infectious diseases, and beyond.

Pan-tumor circulating tumor DNA testing in the community oncology setting.

e14556 Background: Circulating tumor DNA (ctDNA) technology allows for monitoring the genomic profile of cancer over time non-invasively, and in a way that is more representative of existing tumor clones than tissue sampling. The clinical and research applications of this new technology are numerous, and they are potentiated through serial ctDNA testing of individual patients. It is important to identify and characterize real-world data sets that will permit the development of both ctDNA’s clinical and research applications. Methods: This is an observational study of breast, non-small cell lung cancer (NSCLC), colorectal and prostate cancer patients who had ctDNA testing in The US Oncology Network from August 2014 to August 2023. All unique ctDNA reports per patient were collected, along with the report dates and patient characteristics. Rate of change in number of unique reports per month through time was evaluated as well as frequencies of serial testing and median time lapse between diagnosis and date of first ctDNA test by cancer type. Results: Number of new unique ctDNA testing reports per month increased for The US Oncology Network from 2014 through 2018 at a rate of 0.86 (95% CI [0.70, 1.02]). From 2018 to 2023 this rate increased to 5.87 (95% CI [5.16, 6.59]) new reports per month. The total number of unique patients with one of the 4 cancer indications and at least one ctDNA test during the study time period was 10,852. The cancer indication with greatest number of patients with ctDNA testing is NSCLC with 5,503 patients, followed by breast with 2,408, and colorectal and prostate with 1,544 and 1,397 respectively. Black patients were equally represented across all 4 cancers at rates of 13.6% for colorectal, 12.7% for breast, and 12% for NSCLC and prostate. Patients over 65 made up 66% for prostate and NSCLC but only 38% and 32% for colorectal and breast respectively. Most patients presented with a single ctDNA test (n = 9482), but an important proportion presented with 2 serial ctDNA tests or more (n = 1370, 12.6%).The median time between either cancer diagnosis date or date of first visit in The Network and the date of the first ctDNA test report was 39 days for NSCLC, 1,690 days for breast, 377 days for colorectal and 772 days for prostate, and presented with a skewed, long right tailed distribution. Median times were similar for Black and White patients across all cancers. Conclusions: The number of patients with ctDNA testing data available is increasing through time without evidence of plateauing. Although the total number of patients represented is still a very small fraction of the total patient population, the rate of increase in number of new reports through time is equivalent to an exponential increase in the total number of reports. 12.6% of patients presented with two tests or more, potentially allowing for pre and post treatment assessments. There’s an opportunity to better align cancer research and cancer treatment paradigms with this new technology.

Temporal dissociation between local and global functional adaptations of the maternal brain to childbirth: a longitudinal assessment.

The maternal brain undergoes significant reorganization during birth and the postpartum period. However, the temporal dynamics of these changes remain unclear. Using resting-state functional magnetic resonance imaging, we report on local and global brain function alterations in 75 mothers in their first postpartum week, compared to 23 nulliparous women. In a subsample followed longitudinally for the next six months, we observed a temporal and spatial dissociation between changes observed at baseline (cluster mass permutation: pFWE < 0.05). Local activity and connectivity changes in widespread neocortical regions persisted throughout the studied time period (ANCOVAs vs. controls: pFDR < 0.05), with preliminary evidence linking these alterations to behavioral and psychological adaptations (interaction effect with postpartum time: uncorrected p < 0.05). In contrast, the initially reduced whole-brain connectivity of putamen-centered subcortical areas returned to control levels within six to nine weeks postpartum (linear and quadratic mixed linear models: pFDR < 0.05). The whole-brain spatial colocalization with hormone receptor distributions (Spearman correlations: pFDR < 0.05) and preliminary blood hormone associations (interaction effect with postpartum time: uncorrected p < 0.05) suggested that the postpartum restoration of progesterone levels may underlie this rapid normalization. These observations enhance our understanding of healthy maternal brain function, contributing to the identification of potential markers for pathological postpartum adaptation processes, which in turn could underlie postpartum psychiatric disorders.

Abstract PO5-02-04: Irish National Analysis of the Clinical and Economic impact of 21-gene Oncotype DX® testing in Early-Stage, 1-3 lymph node positive, Hormone Receptor positive (HR+), HER2-Negative (HER2-), Breast Cancer (BC)

Abstract PO5-02-04: Irish National Analysis of the Clinical and Economic impact of 21-gene Oncotype DX® testing in Early-Stage, 1-3 lymph node positive, Hormone Receptor positive (HR+), HER2-Negative (HER2-), Breast Cancer (BC)

Has the Prevalence of Creaky Voice Increased Among Finnish University Students From the 1990'S to the 2010'S?

Everyday observations indicate that creaky voice has become common in Finland in recent years. Previous studies suggest that this trend is also occurring in other countries. This cross-sectional study investigates the use of creaky voice among Finnish university students from the 1990's to the 2010's. Material was obtained from a sound archive. It consisted of 200 samples from normophonic speakers (95 males, 105 females; mean age 23.7 years, SD 3.3 years, range 19-35 years). Normophonia was checked by two speech therapists in a preliminary perceptual analysis. Thereafter, two voice specialists rated the amount of creak and strain. A scale of 0-4 was used (0=none, 4=a lot). The inter- and intrarater reliability for the listening evaluations were satisfactory (for creaky phonation, rho=0.611, P < 0.001 for interrater reliability and rho=0.540, P < 0.001 for intrarater reliability; for strain, rho=0.463, P < 0.001 and rho=0.697, P < 0.001 for inter- and intrarater reliability, respectively). These results revealed a significant increase in the amount of perceived creak in females (from 1.04, SD 0.69 to 1.55, SD 1.06; P < 0.05, Mann-Whitney U test). In males, no significant change was found. However, the frequency of creaky voice use increased in both genders. No male speakers from the 1990's were rated as using "a lot" of creaky voice, but 2.3% of male speakers from the 2010's received this rating. Male speakers who were rated "quite a lot" increased from 5.9% in the 1990's to 18.1% in the 2010's. Female speakers rated "a lot" increased from 0% to 6%, and female speakers rated "quite a lot" increased from 7% to 25.8% over the studied time periods. Creaky phonation and strain correlated slightly in males (rho=0.24, P < 0.05) and moderately in females (rho=0.55, P < 0.001). Age did not correlate with the amount of creaky phonation (rho=0.005, P > 0.10 for males, rho=-0.011, P > 0.10 for females). It can be concluded that the prevalence of creaky voice has increased among young Finnish speakers, particularly females.

Trends in volumes and survival after hematopoietic cell transplantation in racial/ethnic minorities

AbstractThere has been an increase in volume as well as an improvement in overall survival (OS) after hematopoietic cell transplantation (HCT) for hematologic disorders. It is unknown if these changes have affected racial/ethnic minorities equally. In this observational study from the Center for International Blood and Marrow Transplant Research of 79 904 autologous (auto) and 65 662 allogeneic (allo) HCTs, we examined the volume and rates of change of autoHCT and alloHCT over time and trends in OS in 4 racial/ethnic groups: non-Hispanic Whites (NHWs), non-Hispanic African Americans (NHAAs), and Hispanics across 5 2-year cohorts from 2009 to 2018. Rates of change were compared using Poisson model. Adjusted and unadjusted Cox proportional hazards models examined trends in mortality in the 4 racial/ethnic groups over 5 study time periods. The rates of increase in volume were significantly higher for Hispanics and NHAAs vs NHW for both autoHCT and alloHCT. Adjusted overall mortality after autoHCT was comparable across all racial/ethnic groups. NHAA adults (hazard ratio [HR] 1.13; 95% confidence interval [CI] 1.04-1.22; P = .004) and pediatric patients (HR 1.62; 95% CI 1.3-2.03; P < .001) had a higher risk of mortality after alloHCT than NHWs. Improvement in OS over time was seen in all 4 groups after both autoHCT and alloHCT. Our study shows the rate of change for the use of autoHCT and alloHCT is higher in NHAAs and Hispanics than in NHWs. Survival after autoHCT and alloHCT improved over time; however, NHAAs have worse OS after alloHCT, which has persisted. Continued efforts are needed to mitigate disparities for patients requiring alloHCT.

When Antimicrobial Treatment and Surgical Prophylaxis Collide: A Stewardship Opportunity.

Background: In 2002, the Centers for Medicare and Medicaid Services (CMS) in collaboration with the Centers for Disease Control and Prevention (CDC) established the Surgical Infection Prevention (SIP) project for the purposes of developing and standardizing quality improvement measures known to reduce the rates of post-operative surgical site infections (SSIs). Four years later the Surgical Care Improvement Project (SCIP), an expansion of SIP, was published in governmental Specifications Manual for National Inpatient Quality Measures and provided several additional initiatives applicable to the perioperative period. Central to both projects are the assurance of the timeliness, selection, and duration of peri-operative surgical prophylactic antibiotics. In support of this objective, various medical associations, such as the American Society of Health-System Pharmacists (ASHP) and the Infectious Diseases Society of America (IDSA), have developed the Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. To ensure compliance with quality measures, hospitals are required to report data to the Physicians Quality Reporting System, which is then reviewed by CMS for reimbursement purposes and to measure hospital performance. To maintain optimal standards of care and satisfy all core measures, it is expected that patients undergoing most categories of surgical procedures receive prophylactic antibiotics. We recognized that patients already being administered antimicrobial therapy as treatment for the condition requiring the surgery not uncommonly also were prescribed unwarranted and redundant pre-operative antibiotics. Our study was meant to quantify such antibiotic redundancy, which only risks the development of antimicrobial resistance and adverse events, to bolster our and other hospitals antimicrobial stewardship programs. Methods: A retrospective analysis of computerized hospital records over a one-month period of time (November 2022) was conducted focusing on hospital admissions that involved surgical operative procedures. Only those patients who had received a pre-operative surgical prophylactic antibiotic were included in the analysis. Results: Of the 92 surgeries that fulfilled the inclusion criteria, 38 (41.3%) were performed on patients who were already receiving therapeutic antibiotics for more than 24 hours targeted to treat the infection for which they were undergoing surgery. These included laparoscopic cholecystectomy (24), appendectomy (12), wound debridement (12), and soft tissue incision and drainage procedures (9), comprising nearly 50% of each type of these operations performed during the study time period. Conclusion: These findings demonstrate a clear opportunity to strengthen both our, and presumably other, hospitals antimicrobial stewardship programs. Together with physician education, granting the pharmacy the ability to cancel unnecessary and redundant surgical prophylactic antibiotics would conceivably be of great benefit.

Knowledge, Attitude and Practice Regarding Breast Cancer and Screening Among Female Health Workers at Birat Medical College Teaching Hospital .

Introduction: In Nepal, breast cancer is the second most common cancer amongst women. Objectives: The objective of this study is to analyze the knowledge, attitudes and practices of health care female professional regarding breast cancer and screening. Methodology: A cross sectional study was done among the female healthcare workers in the department of Medical Oncology from 1st November 2021 to 1st December 2021. Purposive sampling technique was applied for sampling. After consent , questionnaire set regarding the research was provided to the female care professionals. The interview was conducted under the supervision of matron of nursing department. The collected data were analyzed with the help of SPSS Statistic software. Results: One hundred seven female healthcare professionals participated the study during the study time period. The mean age of them was 25.25 years (20-45 years).55% of them had high level of knowledge regarding risk factors of breast cancer .88% of them had high level of knowledge regarding symptoms of breast cancer .75% of them had good knowledge regarding breast cancer treatment modalities. 69% of them were aware that screening helps in prevention of breast cancer amongst which 61% participants agreed for screening themselves for breast cancer . 72% of them were involved in self breast examination .A total of 4.6% of them were unaware of mammograms and 93.4% had never undergone mammogram. Conclusion : Present study demonstrated a good knowledge regarding breast cancer but poor practice regarding breast cancer screening methods among the female health care workers at Birat Medical College Teaching Hospital.

Research of the Dynamics of Mortality of the Population of Kyrgyzstan from COVID-19 and Its Visualization

In this article was considered a dynamic of mortality in Kyrgyzstan from COVID-19. The time period for study is 2020. As an initial data were used data of the National Statistics Committee and Ministry of Health and Social Development of the Kyrgyz Republic. The research methodology is described in detail and the research results are reflected.

Coastal transgressive dunefield evolution as a response to multi-decadal shoreline erosion

The Younghusband Peninsula coastal barrier extends ∼190 km and is predominantly comprised of a mix of active, semi-stabilised and stabilised (relict) transgressive and parabolic dunefields. Wave driven shoreline erosion has triggered the rapid development of a transgressive dunefield along a portion the peninsula. This study focuses on a ∼2 km region with the highest regional erosion rates (> −2.0 m/year since 1988), and which has experienced rapid destabilisation and subsequent landward translation of the dunefield. Aerial LIDAR derived datasets of the barrier system from 2008 and 2018 and eight drone photogrammetry surveys between August 2020 and April 2022 are used to compare the rates of change across the beach-dune system. The net and intra-survey changes are used to show the short- to medium-term system response and illustrate the relationship of sediment dynamics to the developing morphology and structure of the dunefield. Shoreline change rates (m/yr) are sourced from the Digital Earth Australia coastlines dataset which provides annual rates for continental Australia from a Landsat time series (1988–2021). When the rate of shoreline change is segmented from the total dataset to the study time-period (2008–2021), the average resulting rates show an increase from −2.2 m/yr to −3.3 m/yr, respectively. This coincides with a landward advance rate of >10 m/yr from 2008 of the dunefield edge, with the fastest eroding dune toes corresponding to regions with the highest rate of dunefield translation and transgression. Net volumetric totals and their ratios of gain to loss of sediments show that significant sediment is lost to offshore during the retrogradation of the dunefield as only a fraction of the stoss slope sediment is transferred landwards. All regions of the dunefield exhibit a net loss of sediments but the high-temporal resolution shows that the magnitude of 3D changes varies through time. An adapted model of erosional stoss slope evolution and dunefield development is advanced and a temporal model of transgressive dunefield evolution is synthesised.

Exploring the Link between Chronic Inflammation and Atherosclerosis-Endometriosis Association

Background: Atherosclerotic cardiovascular disease (ASCVD) and endometriosis are both inflammatory diseases with significant implications for clinical practice and public health. Evidence Acquisition: To examine the clinical question regarding the relationship between ASCVD and endometriosis, we gathered data from various sources, including research studies and subsequent reference searches of retrieved articles. Our research strategies focused on identifying high-quality evidence through comprehensive study time periods and rigorous methods for quality assessment and article inclusion. Results: Our review of the literature reveals significant findings regarding the interplay between ASCVD and endometriosis. Both conditions share inflammation as a key factor in their pathophysiology. Inflammation not only contributes to the initiation and progression of vascular damage in ASCVD but also plays a role in the development and persistence of endometriosis. Women with endometriosis demonstrate higher levels of inflammatory markers and endothelial activation. Conclusions: Based on the available evidence, we conclude that there is a likely genetic link between ASCVD and the development of endometriosis. Additionally, the influence of estrogen on ASCVD varies depending on the stage of atherosclerosis. While estrogen may be protective in women with early artery blockages, it can pose a potential risk to those with established atherosclerosis. Clinicians should consider these factors when managing patients with ASCVD and endometriosis to optimize care.

Role of strengthening exercises in management and prevention of overuse sports injuries of lower extremity: a systematic review.

Overuse injuries are common in sports involving jumping, running, and landing, due to the repetitive nature of these activities and the strain they place on the lower extremity. The objective of the study was to determine the role of strengthening exercises in the management of overuse sports injuries of lower extremity and its effects on prevention of injury recurrence. This study employed a systematic review design. The author extracted and reviewed the papers for this study in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and then used the PEDro scale to rate the articles' quality. For the most recent and well-developed primary data, several electronic databases including Google Scholar, PubMed Central, MEDLINE, Cochrane Library, and PEDro were exhaustively searched. Inclusion criteria were based on PICO (T) model and included study population, intervention nature, outcome measures, time period, methodological quality, and linguistic extent. The data synthesis involved analyzing randomized control/clinical trials on strengthening exercises for lower extremity overuse sports injuries in athletes, considering outcomes including muscle strength, pain scores, return to sports, and injury prevention. The methodological quality of the recruited articles ranged from excellent to fair on PEDro scale. Three included studies investigated the effects of strengthening exercises on management of lower extremity injuries of athletes. Four studies evaluated its role on prevention from recurrence of injuries. This study has concluded that strength training plays a fundamental role in management and prevention of overuse injuries. It not only improves the muscle performance, fitness level, speed and agility in sports but also decreases the pain, and aids in early recovery from an injury.

Unveiling the evolving landscape of stroke care costs: A time-driven analysis

IntroductionStroke is a common cause of mortality in the United States. However, the economic burden of stroke on the healthcare system is not well known. In this study, we aim to calculate the annual cumulative and per-patient cost of stroke. MethodsWe conducted a retrospective analysis of Nationwide Emergency Department Sample (NEDS). We calculate annual trends in cost for stroke patients from 2006 to 2019. A multivariate linear regression with patient characteristics (e.g. age, sex, Charlson Comorbidity Index) as covariates was used to identify factors for higher costs. ResultsIn this study time-period, 2,998,237 stroke patients presented to the ED and 2,481,171 (83 %) were admitted. From 2006 to 2019, the cumulative ED cost increased by a factor of 7.0 from 0.49 ± 0.03 to 3.91 ± 0.16 billion dollars (p < 0.001). The cumulative inpatient (IP) cost increased by a factor of 2.7 from 14.42 ± 0.78 to 37.06 ± 2.26 billion dollars (p < 0.001. Per-patient ED charges increased by a factor of 3.0 from 1950 ± 64 to 7818 ± 260 dollars (p < 0.001). Per-patient IP charges increased by 89 % from 40.22 +/- 1.12 to 76.06 ± 3.18 thousand dollars (p < 0.001). ConclusionStrokes place an increasing financial burden on the US healthcare system. Certain patient demographics including age, male gender, more comorbidities, and insurance type were significantly associated with increased cost of care.

Disparities in Liver Transplantation for Nonalcoholic Steatohepatitis in Women.

Nonalcoholic steatohepatitis (NASH) is the fastest-growing indication for liver transplantation (LT). Sex disparities among patients with cirrhosis on the LT waitlist are well known. We wanted to understand these disparities further in women with end-stage liver disease patients listed for NASH cirrhosis in a contemporary cohort. We used data from the Scientific Registry of Transplant Recipients to assess sex racial, and ethnic differences in NASH patients listed for LT. Adults transplanted from August 1997 to June 2021 were included. Inferential statistics were used to evaluate differences with univariate and multivariate comparisons, including competitive risk analysis. During the study time period, we evaluated 12 844 LT for NASH cirrhosis. Women were transplanted at a lower rate (46.5% versus 53.5%; P < 0.001) and higher model for end-stage liver disease (MELD) (23.8 versus 22.6; P < 0.001) than men. Non-White women were transplanted at a higher MELD (26.1 versus 23.1; P < 0.001) than White women and non-White male patients (26.1 versus 24.8; P < 0.001). Graft and patient survivals were significantly different ( P < 0.001) between non-White women and White women and men (White and non-White). Evaluation of LT candidates in the United States demonstrates women with NASH cirrhosis have a higher MELD than men at LT. Additional disparities exist among non-White women with NASH as they have higher MELD and creatinine at LT compared with White women. After LT, non-White women have worse graft and patient survival compared with men or White women. These data indicate that non-White women with NASH are the most vulnerable on the LT waitlist.

Examining Barriers to Early Hearing Diagnosis.

Many factors create barriers for early hearing detection and intervention (EHDI), especially those related to unfavorable social determinants of health (SDOH). The primary aim of this study was to evaluate diagnostic timing of infants at risk for congenital hearing loss in consideration of known barriers. Understanding the specific barriers to early diagnosis can inform interventions to improve timeliness of diagnosis and subsequent habilitation. A retrospective chart review was completed for infants referred for diagnostic audiologic testing at a tertiary urban-setting Children's Hospital from 2018 to 2021. After exclusion criteria were applied, 1,488 infants were included in the analysis. Various factors were recorded from electronic medical records including those specific to SDOH. Time to diagnosis was derived and compared across five factors of interest that have previously been shown to impact diagnostic timeline, including (a) insurance type, (b) race/ethnicity, (c) presence of middle ear dysfunction at first auditory brainstem response (ABR), (d) proximity to diagnostic center, and (e) diagnostic timing before and during/after the COVID-19 pandemic. Across the study time period, 77% of infants referred for diagnostic testing had confirmed diagnosis by the EHDI benchmark of 3 months. Analysis of time to diagnosis across factors of interest revealed no clinically significant differences for insurance type, race/ethnicity, proximity to diagnostic center, or timing in reference to the COVID-19 pandemic. Presence of middle ear dysfunction on first ABR was found to significantly protract final diagnostic timing. Although some known barriers for EHDI can be universal, other factors may have a differential impact on an infant's timeline to diagnosis based on their specific location, which can interact differently with additional known barriers. Understanding local challenges will serve to better guide programs in implementing facilitators that will address their specific needs for improved outcomes.

Risk Factors for Early Dental Implant Failure.

To report the prevalence of early implant failure and evaluate factors that contribute to the early failure of dental implants placed at a teaching clinic. The study also aims to identify risk indicators for early implant loss to better predict and prevent early implant loss in the future. This retrospective study included all patients with a dental implant placed by the Section of Oral Surgery and Oral Medicine, Department of Clinical Dentistry, University of Bergen, between January 2011 and December 2018. All information was collected from operation logbooks and from patient records. A failed implant in this study was defined as an implant lost before functional loading. A total of 1,005 dental implants were placed in the studied time period, of which 54 failed early, giving an early failure rate (EFR) of 5.4%, with functional loading obtained for the remaining 94.6%. Analysis showed an increased hazard for early implant failure among smokers, men, and younger patients. With an age increase of 10 years, the risk of implant failure was reduced by 14% (hazard ratio [HRR] = 0.86, P = .037). A higher failure rate was found in anterior maxillary implants than in posterior maxillary implants (7.79% vs 3.29%, respectively; HRR = 0.47; P = .041). The probability for early failure in the posterior mandible was significantly increased compared to the posterior maxilla (HRR = 3.68, P = .005). If the first implant failed, it was more likely that the consecutive implant would also fail (HRR = 1.82). In the study, 53.4% of the placed implants were Straumann (EFR = 5.2%), 30.3% were Nobel Biocare (EFR = 7.2%), and 16.3% were Astra Tech (EFR = 2.5%). This study found that younger, male, and smoker patients were associated with an increase in early failure of dental implants. Significantly increased failure rates were also seen for implants placed in the mandible, and there were differences with respect to implant system. Although differences were found in early failure both for patient- and implant-related factors, the overall early failure rate (5.4%) in this study was low.

Identifying Predictors of Initial Surgical Failure during Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation.

Background and Purpose: Intracerebral hemorrhage (ICH) is a common and severe disease with high rates of morbidity and mortality; however, minimally invasive surgical (MIS) hematoma evacuation represents a promising avenue for treatment. In February of 2019, the MISTIE III study found that stereotactic thrombolysis with catheter drainage did not benefit patients with supratentorial spontaneous ICH but that a clinical benefit may be present when no more than 15 mL of hematoma remains at the end of treatment. Intraoperative CT (iCT) imaging has the ability to assess whether or not this surgical goal has been met in real time, allowing for operations to add additional CT-informed 'evacuation periods' (EPs) to achieve the surgical goal. Here, we report on the frequency and predictors of initial surgical failure on at least one iCT requiring additional EPs in a large cohort of patients undergoing endoscopic minimally invasive ICH evacuation with the SCUBA technique. Methods: All patients who underwent minimally invasive endoscopic evacuation of supratentorial spontaneous ICH in a major health system between December 2015 and October 2018 were included in this study. Patient demographics, clinical and radiographic features, procedural details, and outcomes were analyzed retrospectively from a prospectively collected database. Procedures were characterized as initially successful when the first iCT demonstrated that surgical success had been achieved and initially unsuccessful when the surgical goal was not achieved, and additional EPs were performed. The surgical goal was prospectively identified in December of 2015 as leaving no more than 20% of the preoperative hematoma volume at the end of the procedure. Descriptive statistics and regression analyses were performed to identify predictors of initial failure and secondary rescue. Results: Patients (100) underwent minimally invasive endoscopic ICH evacuation in the angiography suite during the study time period. In 14 cases, the surgical goal was not met on the first iCT and multiple Eps were performed; in 10 cases the surgical goal was not met, and no additional EPs were performed. In 14 cases, the surgical goal was never achieved. When additional EPs were performed, a rescue rate of 71.4% (10/14) was seen, bringing the total percentage of cases meeting the surgical goal to 86% across the entire cohort. Cases in which the surgical goal was not achieved were significantly associated with older patients (68 years vs. 60 years; p = 0.0197) and higher rates of intraventricular hemorrhage (34.2% vs. 70.8%; p = 0.0021). Cases in which the surgical goal was rescued from initial failure had similar levels of IVH, suggesting that these additional complexities can be overcome with the use of additional iCT-informed EPs. Conclusions: Initial and ultimate surgical failure occurs in a small percentage of patients undergoing minimally invasive endoscopic ICH evacuation. The use of intraoperative imaging provides an opportunity to evaluate whether or not the surgical goal has been achieved, and to continue the procedure if the surgeon feels that more evacuation is achievable. Now that level-one evidence exists to target a surgical evacuation goal during minimally invasive ICH evacuation, intraoperative imaging, such as iCT, plays an important role in aiding the surgical team to achieve the surgical goal.